Patient Access Representative- Insurance Verification and Authorization - Corporate 42nd St- Full-Time- Days (M-F & 1 Saturday Monthly)

Job description

Description
Patient Access Representative- Insurance Verification and Authorization - Corporate 42nd St- Full-Time- Days (M-F & 1 Saturday Monthly)
Obtains complete and accurate demographic and insurance information by ensuring all relative data is collected. Interviews patients over the telephone, to make sure all information is secured and documented in the Eagle System. Answers phones courteously and efficiently.
Responsibilities
• Accesses EPIC system to secure cases scheduled for ambulatory and in-patient procedures.
• Ensures that the appropriate authorization/predetermination requirements have been secured based on procedure & ICD10 codes booked by physicians offices.
• Notifies patient/physician, via email, of insurance/pre-certification deficiencies that require immediate attention to secure patient account in a timely fashion.
• Checks the IP only CPT List to ensure cases are booked in appropriate setting for Medicare and Medicaid Fee for Service as well as HMO, PCP payers.
• Secure additional information from the physician or patient to financially secure the account before releasing the case for final billing.
• Ensure that clear and consistent memo notations are posted on all actions taken on cases worked. Serves as proof of documentation for follow up needed if case is denied.
• Refer unsecured cases to management in addition to emailing the service area/physician to initiate follow up on securing the case. (Front End-Admitting/ Physician Offices)
• Refer underinsured / uninsured cases to Management as well as Financial Counseling Department as appropriate.
• Pre-Admits patients in Eagle system, validate insurances booked to make sure they are active at time of registration, assign appropriate primary payer financial class based on verification. Refer to management / service area if insurance is inactive to secure case.
• Review EPIC /IPATH schedule intermittently throughout the day to reconcile all cases, including last minute add ons added to schedule to ensure they are also secured timely.
• Continuously refer back to service areas / management any case that does not meet criteria and is at risk for Denial.
• Stat edits accounts registered 48 hours from service date to Ontrac to meet Department goal of remaining 3 to 5 days out secure.
• Notifies the patient of any deposits or financial liability they are required to pay on date of procedure. Enter memo notations of patient notification.
• Obtains credit card number for said liability when possible, and contacts the patient to collect pre service at least one prior to service date.
• Consistent accuracy in data entry a must (correct payer financial class) with a clear memo notation in Eagle to identify all steps taken to secure the services rendered.
• Refer to Management on all the cases that do not meet standards for patient access clearance.
• Demonstrate an ability to organize and achieve quality performance with new routines, procedures.
• Demonstrate an ability to gather and maintain complete, appropriate collection of data to increase the overall efficiency at maximum potential.
• Secure complete insurance information, ie: rule out Dependent Coverage information which includes documenting COB confirmation and completion of required questionnaire documents.
• Ensuring Medicare MSP questions are documented in Eagle completely and accurately for auditing preparedness.
• Consistently demonstrate the ability to recognize, establish and deal with priorities and seeking assistance from management as needed.
• Maintains accurate reconciliation system for pre-admissions, admissions, and ambulatory surgeries.
• Reviews and completes all the inflow accounts from EPIC / Ontrac work list and codes them timely and accordingly.
• Possesses knowledge of third party insurance requirements as relates to in-patient, ambulatory surgery, and the maternity and behavioral health admissions
• Processes and submit completed accounts in a timely basis according to the departmental needs as required.
• Listens closely to all the customers requests and concerns and follows through appropriately.
• All other duties as necessary to financially secure patients accounts as assigned by management.

Qualifications
• Applicable work experience may be considered in lieu of educational requirements. High school graduate or equivalent.
• Must possess knowledge of the Eagle ADT system. Familiar with the third party Insurance verification process and regulations. Keypunching experience is required. Ability to multi task between different Systems. EPIC/ EAGLE / HURON-Ontrac & different payer websites to access benefits/authorization, including submissions.

Collective bargaining unit: SEIU 1199-MSBI
Employer Description
Strength through Unity and Inclusion
The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.
At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.
About the Mount Sinai Health System:
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.
Equal Opportunity Employer
The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.
Compensation
The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $29.6964 - $31.4892 Hourly. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
• Accesses EPIC system to secure cases scheduled for ambulatory and in-patient procedures.
• Ensures that the appropriate authorization/predetermination requirements have been secured based on procedure & ICD10 codes booked by physicians offices.
• Notifies patient/physician, via email, of insurance/pre-certification deficiencies that require immediate attention to secure patient account in a timely fashion.
• Checks the IP only CPT List to ensure cases are booked in appropriate setting for Medicare and Medicaid Fee for Service as well as HMO, PCP payers.
• Secure additional information from the physician or patient to financially secure the account before releasing the case for final billing.
• Ensure that clear and consistent memo notations are posted on all actions taken on cases worked. Serves as proof of documentation for follow up needed if case is denied.
• Refer unsecured cases to management in addition to emailing the service area/physician to initiate follow up on securing the case. (Front End-Admitting/ Physician Offices)
• Refer underinsured / uninsured cases to Management as well as Financial Counseling Department as appropriate.
• Pre-Admits patients in Eagle system, validate insurances booked to make sure they are active at time of registration, assign appropriate primary payer financial class based on verification. Refer to management / service area if insurance is inactive to secure case.
• Review EPIC /IPATH schedule intermittently throughout the day to reconcile all cases, including last minute add ons added to schedule to ensure they are also secured timely.
• Continuously refer back to service areas / management any case that does not meet criteria and is at risk for Denial.
• Stat edits accounts registered 48 hours from service date to Ontrac to meet Department goal of remaining 3 to 5 days out secure.
• Notifies the patient of any deposits or financial liability they are required to pay on date of procedure. Enter memo notations of patient notification.
• Obtains credit card number for said liability when possible, and contacts the patient to collect pre service at least one prior to service date.
• Consistent accuracy in data entry a must (correct payer financial class) with a clear memo notation in Eagle to identify all steps taken to secure the services rendered.
• Refer to Management on all the cases that do not meet standards for patient access clearance.
• Demonstrate an ability to organize and achieve quality performance with new routines, procedures.
• Demonstrate an ability to gather and maintain complete, appropriate collection of data to increase the overall efficiency at maximum potential.
• Secure complete insurance information, ie: rule out Dependent Coverage information which includes documenting COB confirmation and completion of required questionnaire documents.
• Ensuring Medicare MSP questions are documented in Eagle completely and accurately for auditing preparedness.
• Consistently demonstrate the ability to recognize, establish and deal with priorities and seeking assistance from management as needed.
• Maintains accurate reconciliation system for pre-admissions, admissions, and ambulatory surgeries.
• Reviews and completes all the inflow accounts from EPIC / Ontrac work list and codes them timely and accordingly.
• Possesses knowledge of third party insurance requirements as relates to in-patient, ambulatory surgery, and the maternity and behavioral health admissions
• Processes and submit completed accounts in a timely basis according to the departmental needs as required.
• Listens closely to all the customers requests and concerns and follows through appropriately.
• All other duties as necessary to financially secure patients accounts as assigned by management.